Clinical evaluation of a bone cement-injectable cannulated pedicle screw augmented with polymethylmethacrylate: 128 osteoporotic patients with 42 months of follow-up

Abstract

OBJECTIVES: To evaluate the safety and efficacy of a novel bone cement-injectable cannulated pedicle screw augmented with polymethylmethacrylate in osteoporotic spinal surgery. METHODS: This study included 128 patients with osteoporosis (BMD T-score –3.2±1.9; range, –5.4 to –2.5) who underwent spinal decompression and instrumentation with a polymethylmethacrylate-augmented bone cement-injectable cannulated pedicle screw. Postoperative Visual Analogue Scale scores and the Oswestry Disability Index were compared with preoperative values. Postoperative plain radiographs and computed tomography (CT) scans were performed immediately after surgery; at 1, 3, 6, and 12 months; and annually thereafter. RESULTS: The mean follow-up time was 42.4±13.4 months (range, 23 to 71 months). A total of 418 polymethylmethacrylate-augmented bone cement-injectable cannulated pedicle screws were used. Cement extravasations were detected in 27 bone cement-injectable cannulated pedicle screws (6.46%), mainly in cases of vertebral fracture, without any clinical sequela. The postoperative low back and lower limb Visual Analogue Scale scores were significantly reduced compared with the preoperative scores (<0.01), and similar results were noted for the Oswestry Disability Index score ( p <0.01). No significant screw migration was noted at the final follow-up relative to immediately after surgery ( p <0.01). All cases achieved successful bone fusion, and no case required revision. No infection or blood clots occurred after surgery. CONCLUSIONS: The polymethylmethacrylate-augmented bone cement-injectable cannulated pedicle screw is safe and effective for use in osteoporotic patients who require spinal instrumentation.

Comparison of unilateral and bilateral polymethylmethacrylate-augmented cannulated pedicle screw fixation for the management of lumbar spondylolisthesis with osteoporosis

“…The biomechanical stability of pedicle screw xation systems is particularly important in patients with lumbar spondylolisthesis and osteoporosis (11,24). Studies have shown that the use of PMMAaugmented CPSs to reconstruct the displaced vertebral body and perform bony fusion is still the main surgical method for these patients (19,20,(24)(25)(26)(27)(28). Theoretically, more CPSs require a greater holding force by internal xation; however, overuse of CPSs may increase the risk of complications related to PMMA leakage, including allergic reactions, venous or pulmonary embolism, and di culty with revision.…”

“…A suitable cage was lled with crushed autologous bone for fusion, then rods were installed and nuts were locked. In this study, a new type of PMMA-augmented CPS, named 'bone cement injectable cannulated pedicle screw (CICPS)' was developed by the authors for reduction and xation, a detailed introduction of which was reported in detail in previous studies (17)(18)(19)(20).…”

Comparison of Unilateral and Bilateral Polymethylmethacrylate-augmented Cannulated Pedicle Screw Fixation for Management of Lumbar Spondylolisthesis with Osteoporosis

“…Lumbar spondylolisthesis with osteoporosis has great requirements for the biomechanical stability of pedicle screws xation system (11,24). Studies have shown that CPSs augmented by PMMA to reconstruct the displaced vertebral body and perform bony fusion is still the main surgical method for these patients (19,20,(24)(25)(26)(27)(28). Theoretically, the more CPSs used the greater holding force supplied by the internal xation.…”

“…There are very few reports on the accurate and reasonable application guidelines of CPSs to improve the rationality in clinical practice. We reviewed the published literatures and fund that some studies using CPSs in bilateral sides (25)(26)(27)(28), while other studies using in unilateral side partially (17,19,20). Therefore, it has great clinically value to explore whether unilateral PMMA-augmented CPSs can provide adequate stability compared with bilateral PMMA augmentation, as well as whether any difference exist in the effectiveness and complications between the two methods.…”

“…A suitable cage was lled with crushed autologous bone for fusion, then rods were installed and nuts were locked. In this study, a new type of PMMA-augmented CPS named bone cement-injectable cannulated pedicle screw (CICPS) was developed by authors for reduction and xation, a system introduction of which was reported in detail in previous literatures (17)(18)(19)(20).…”